ROLE OF PATIENT SPECIFICS ON MECHANICAL RISK AND LOAD RELIEF DURING SUPPORT OF BONY PROMINENCES

摘要

Prolonged mechanical loading of tissue in between a bony prominence and a support surface can lead to pressure ulcers. Despite recent initiatives to curb down incidence rates, the health care burden of pressure ulcer prevention remains significant [1]. Etiology of pressure ulcers are commonly attributed to interface pressures. As a result, interventions, e.g., support surfaces, routinely aim to reduce contact pressures. However, the clinical effectiveness of such an objective can be questionable [2]. Recent studies have shown that internal mechanics of the tissue can be associated with pressure ulcer development [3], potentially indicating the inefficacy of interventions targeted solely at contact pressure relief. Tissue characteristics at a bony prominence, e.g., tissue thickness and material properties, also influence load distribution within and on the surface of the tissue. Given the variability in patient populations and for a bony region of interest [4], it is possible that patient specific risk and load relief (with the use of support surface) may differ widely. Finite element analysis has been utilized to understand the etiology of pressure ulcers [5] and also to predict performance of support surfaces [6]. A handful of studies indicated the potential role of tissue thickness [7,8] or material [7,9] on tissue injury. Yet, a comprehensive investigation, driven by patient population data, is missing. The goal of this study was to explore mechanical risk and load relief at a bony prominence, as a function of tissue thickness and material, while illustrating the importance of external and internal mechanical metrics for patient evaluation.